Elsevier

Clinical Nutrition

Volume 36, Issue 1, February 2017, Pages 49-64
Clinical Nutrition

ESPEN Guideline
ESPEN guidelines on definitions and terminology of clinical nutrition

https://doi.org/10.1016/j.clnu.2016.09.004Get rights and content

Summary

Background

A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

Objective

This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

Methods

The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

Results

Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

Conclusion

An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

Introduction

Nutrition plays a pivotal role in life and in medicine. Acute and chronic diseases in most organ systems have pronounced effects on food intake and metabolism with increased catabolism, which lead to nutrition-related conditions associated with increased morbidity and eventually death. At the other end of the spectrum, diet is a major determinant of future health, i.e. the absence or postponement of disorders like cardio-vascular disease, diabetes, cancer and cognitive disease [1].

In order to handle nutritional challenges during disease, trauma, rehabilitation, and elderly care as well as for the nutritional prevention of disease it is essential to use professional language and standard terminology that is founded on evidence and widely accepted in the professional community. However, this is not always the case. For example, concepts and terms of nutritional disorders in the current International Classifications of Diseases (ICD-10) (http://www.who.int/classifications/icd/en/) may not always be consistent with modern understanding or terms commonly used in clinical practice and research.

Therefore, it is important for the nutritional practice and research communities, including dietitians, nurses, pharmacists, physicians and scientists as well as their respective scientific associations, to reach consensus on the terminology and criteria to be used for nutritional disorders as well as for core nutritional procedures such as screening, assessment, treatment and monitoring. A unification of the appropriate terminology would enhance the legitimacy, credibility and comparability of nutritional practices and could also support future updates of disease and procedure related classification systems, such as the ICD system. This may lead to improvements in clinical care and the advancement of the clinical and scientific nutrition fields.

These aims led the European Society for Clinical Nutrition and Metabolism (ESPEN) to appoint a Terminology Consensus Group with the mission to provide such a set of standard terminology with a main focus on adults.

Section snippets

Aim and selection of the expert group

Part of the continuous work of ESPEN is to produce guidelines that support improvements in clinical care and facilitate research. In 2014 new standards for setting ESPEN Guidelines were established [2]. The presented Guideline standard operating procedures (SOP) aimed to generate high quality guidelines using a clear and straight-forward consensus procedure, with one of the goals to establish international leadership in creating up-to-date and suitable-for-implementation guidelines. To provide

Nutritional concepts

Nutrition science deals with all aspects of the interaction between food and nutrients, life, health and disease, and the processes by which an organism ingests, absorbs, transports, utilizes and excretes food substances [4]. [Strong Consensus, 97% agreement]

Human nutrition addresses the interplay of nutrition in humans. Preventive nutrition addresses how food intake and nutrients may affect the risk of developing disease such as cardiovascular disease (CVD), obesity, type 2 diabetes mellitus

Discussion

This definition and terminology consensus statement presents an up-dated overview of terminology of core nutritional concepts, procedures and products. The purpose was to identify relevant nutrition terminology used in routine nutritional practice and research, to describe that terminology and when feasible to give diagnostic or descriptive criteria. Another objective was to identify gaps in the nutritional terminology and to provide consensus based and when possible evidence based definitions

Conflicts of interest

Cederholm T – receives unconditional grants for intervention research from Nestec Ltd and Nutricia. TC gives lectures that are organized by Nestec Ltd, Nutricia, Fresenius Kabi and other companies.

Barazzoni R – declares no conflict of interest which might have interfered with the scientific validity of the present paper.

Austin P – declares no conflict of interest which might have interfered with the scientific validity of the present paper.

Ballmer P – declares no conflict of interest which

Acknowledgement

Many colleagues in the nutrition community have reviewed the manuscript at various levels of its evolution. The Consensus group acknowledges contributions from Yitsal Berner, Ingvar Bosaeus, Michael Chourdakis, Mick Deutz, Henrik Hojgaard Rasmussen, Hinke Kruizenga, Ylva Orrevall, Matthias Plauth, Marjolein Visser, which does not necessarily imply each agrees with all statements in the final manuscript. Moreover, the thorough review and constructive contributions from the Medical Nutrition

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